Provider reimbursement cuts announced by Anthem

CDA has learned that Anthem Blue Cross has sent notices to more than 7,000 California dentists in various geographical areas announcing a “fee adjustment” in a number of regions. This “adjustment” appears to be scheduled to go into effect Jan. 1, 2015. Anthem is making other amendments to the Anthem Participating Dentist agreements as well, which apparently will be summarized on a CD to be enclosed with the notice. A CDA-sponsored law requires insurers to provide no less than 45 business days’ notice of any material change to contracts or payment plans, which is likely why Anthem states it does not plan to implement its “fee adjustments” until Jan. 1. 

In its “Notice of Revision to Participating Dentist Agreement” that was sent to providers, Anthem states that it has conducted an evaluation of its fees, market position and competitiveness in various geographical dental markets and has made the decision to “adjust” specialist and general practitioner PP0100, PPO200 and PPO300 Network Fee Schedules … “in specific geographical areas.” 

Anthem representatives confirmed the reductions are expected to be 6 percent or less for the provider fee schedules that were adjusted. The reductions will vary based on whether the participating dentist is a PPO100, PPO200 or PPO300 provider. The PPO200 and PPO300 participating providers will be likely to see greater reductions than those dentists participating in the PPO100 program, as the PPO100 program offers the deepest discounts. We understand that the primary impact will be in ZIP codes around Los Angeles, Oakland, San Francisco, San Jose, Santa Ana and Anaheim. According to Anthem, there are approximately 7,700 “unique” dentists impacted, which means a dentist may be impacted at one or more practice locations, but not another practice outside of the geographic area.

In addition, all Anthem providers will receive a notice regarding program administration amendments. CDA will review these in more detail as information about them becomes available to us and will provide you with that information. CDA understands members’ frustrations and anxiety regarding rate reductions, and we are here to support you in every way we can. We are aware that the cost of providing quality dental care is going up, not down. We have not yet been able to conduct an analysis of any possible legal implications that might be associated with Anthem’s announcement.

If you have any questions regarding Anthem’s actions, Anthem’s notice advises you to call an Anthem network representative at 866.947.9398 between 7:00 a.m. and 4:30 p.m., Monday through Friday.

CDA provides its members with sophisticated practice management and dental benefit guidance through CDA’s Practice Support at 800.232.7645. CDA will continue to provide information regarding Anthem’s reimbursement “adjustment” in the Update, e-newsletter and on cda.org.

Updated: 10/20/14